African Journals Online
Malawi Medical Journal

The Journal of the College of Medicine
and  Medical Association of Malawi

Volume 14 No 2 2002
ABSTRACTS

Prevalence and indicators of HIV and AIDS among adults admitted to medical and surgical wards in Blantyre, Malawi

DK Lewis, M Callaghan, K Phiri, J Chipwete, JG Kublin, E Borgstein, EE Zijlstra

Abstract

Despite high seroprevalence there are few recent studies of the effect of HIV on hospitals in sub-Saharan Africa. We examined 1226 consecutive patients admitted during two 2-week periods in October 1999 and January 2000. 70% medical patients were HIV positive, and 45% had AIDS. 36% surgical patients were HIV positive and 8% had AIDS. Seroprevalence rose to a peak among 30-40 year olds; 91% medical, 56% surgical and 80% all patients in this age group were HIV positive. Seropositive women were younger than seropositive men (median age 29 v 35, p<0.0001). Symptoms strongly indicative of HIV were history of shingles, chronic diarrhoea or fever or cough, history of tuberculosis, weight loss, and persistent itchy rash (adjusted odds ratios all over 5). Clinical signs strongly indicative of HIV were oral hairy leukoplakia, shingles scar, Kaposi’s sarcoma, oral thrush, and hair loss (adjusted odds ratios all over 10). Of surgical patients with ‘deep infections’ (breast abscess, pyomyositis, osteomyelitis, septic arthritis, and multiple abscesses), 52% were HIV positive (OR compared with other surgical patients 2.4). Severe bacterial infections, tuberculosis, and AIDS caused 68% deaths. HIV dominates adult medicine, is a major part of adult surgery, is the main cause of death in hospital, and affects the economically active age group of the population.

Changes in Escherichia coli resistance to co-trimoxazole in tuberculosis patients and in relation to co-trimoxazole prophylaxis in Thyolo, Malawi

R Zachariah, AD Harries, MP Spielmann, V Arendt, D Nchingula, R Mwenda, O Courtielle, P Kirpach, B Mwale, FML Salaniponi

Abstract

In Thyolo district, Malawi, an operational research study is being conducted on the efficacy and feasibility of co-trimoxazole prophylaxis in preventing deaths in HIV-positive patients with tuberculosis (TB). A series of cross-sectional studies were carried out to determine i) whether faecal Escherichia coli (E.coli) resistance to co-trimoxazole in TB patients changed with time and ii) whether the resistance pattern was different in HIV positive TB patients who were taking co-trimoxazole prophylaxis. Co-trimoxazole resistance among E.coli isolates in TB patients at the time of registration was 60% in 1999 and 77% in 2001 (p<0.01).  Resistance was 89% among HIV-infected TB patients (receiving co-trimoxazole), while in HIV negative patients (receiving  anti-TB therapy alone) it was 62% (p<0.001). The study shows a significant increase of E.coli resistance to co-trimoxazole in TB patients which is particularly prominent in HIV infected patients on co-trimoxazole prophylaxis. Since a high degree of plasmid-mediated transfer of resistance exists between E.coli and the Salmonella species, these findings could herald limitations on the short and long term benefits to be anticipated from the use of co-trimoxazole prophylaxis in preventing non-typhoidal salmonella bacteraemia and enteritis in HIV infected TB patients in Malawi.

Mortality in smear-negative tuberculosis patients in Phalombe

JCJ Calis, ML Bakker, RB Elens, M Borgdorff, AD Harries

Abstract

In two hospitals in Malawi, where HIV prevalence among tuberculosis patients is 80-90%, the treatment outcome in patients registered with smear-negative pulmonary tuberculosis was determined in relation to chest x-ray (CXR) findings and certain laboratory parameters. Of 70 patients who were registered and treated, 32 (46%) were known to have died. Mortality was particularly high in those with a normal / minimally abnormal CXR (62%) and in those with a white cell count of less than 3.5 x 10⁹ /l (77%). The reasons for this high mortality among patients with smear-negative PTB are not known and requires more research.

Health seeking and sexual behaviour among patients with sexually transmitted infections - the importance of traditional healers

R Zachariah, W Nkhoma, AD Harries, V Arendt, A Chantulo, MP Spielmann, MP Mbereko, L Buhendwa

Abstract

We aimed to describe health seeking and sexual behaviour including condom use among patients presenting with sexually transmitted infections (STI) and, to identify socio-demographic and behavioural risk factors associated with “no condom use” during the symptomatic period. A cross-sectional study of consecutive new STI cases presenting at the district STI clinic in Thyolo were interviewed by STI counsellors after obtaining informed consent. All patients were treated according to National guidelines. Of 498 new STI clients, 53% had taken some form of medication before coming to the STI clinic, the most frequent alternative source being the traditional healer (37%). 46% of all clients reported sex during the symptomatic period  (median=14 days), the majority (74%) not using condoms. 90% of all those who had not used condoms resided in villages and had seen only the traditional healer. Significant risk factors associated with “no condom use” included:visiting a traditional healer; being female; having less than 8 years of school education; and being resident in villages. Genital ulcer disease (GUD) was the most common STI in males (49%) while in females this comprised 27% of STIs. These findings, especially the extremely high GUD prevalence is of particular concern, considering the high national HIV prevalence in Malawi (9%) and the implications for STI and HIV transmission.  There is an urgent need to integrate traditional healers in control activities, encourage their role in promoting safer sexual behaviour, and to reorient or even change existing strategies on condom promotion and STI control.

The impact of HIV infection on childhood pneumonia: comparison between developed and developing regions

SM Graham

Abstract

Respiratory disease is the commonest cause of morbidity and mortality in HIV-infected children. While the pattern of HIV-related pneumonia in African adults is well documented and is recognised as quite different from that which occurs among HIV-infected adults in high-income regions, less is known of the situation in children. Most children are infected by mother-to-child transmission and presentation of HIV-related pneumonia is often in infancy or early childhood, an age group in which confirmation of the cause of pneumonia is difficult. However, aetiological data are important. Poor response of the infant with severe pneumonia to standard antibiotic (such as chloramphenicol) or of the older child with chronic pneumonia to anti-tuberculosis treatment are two very common clinical dilemmas that many Malawian health workers would recognise. This review aims to present the available data relevant to Malawi, contrast with experience from the developed world and to describe common HIV-related pneumonias such as PCP and LIP. Unlike for adults, the pattern of HIV-related pneumonia in Malawian children may not be so different in cause from that described for children in developed countries prior to the use of PCP prophylaxis and anti-retroviral therapies. The most important contrast is the higher prevalence and poorer outcome.

Revisiting human behaviour in relation to HIV/AIDS

CR Bandawe

Abstract

It is widely recognised that human behaviour change is a key element in the fight against HIV/AIDS. The reality of the situation however is that the current approaches to instigating sexual behaviour change appear to have borne little fruit. This paper shall argue that in the fight against HIV/AIDS, a fundamental error is made in the numerous outreach programmes that exist within Malawi and elsewhere. This error is grounded in the assumptions that are made about how persons respond to the messages garnered to the control of the disease. Until this mistaken assumption is addressed, it is argued that no serious headway shall be made in the control of this disease, which threatens the very fabric of the Malawi nation.